Inspection on 21/01/09 for St Margaret`s Care Home

This inspection was carried out on 21st January 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Margaret`s Care Home 09/02/07

St Margaret`s Care Home 18/01/06

St Margaret`s Care Home 27/07/05

St Margaret`s Care Home 02/02/05

St Margaret`s Care Home 12/07/04

St Margaret`s Care Home 12/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE St Margaret`s Care Home Crossgate St Margarets Garth Durham DH1 4DS Lead Inspector Sue Lowther Key Unannounced Inspection 10:00 21st January & 10th February 2009 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Margaret`s Care Home Address Crossgate St Margarets Garth Durham DH1 4DS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0191 3868949 0191 3868945 stmargarets@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited Manager post vacant Care Home 60 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (49), of places Physical disability (5) St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 49 Physical Disability - Code PD, maximum number of places 5. Dementia, over 65 years of age - Code DE(E), maximum number of places 11 The maximum number of service users who may be accommodated is: 60 28th March 2008 2. Date of last inspection Brief Description of the Service: St Margarets is a purpose built care home. It is situated on the outskirts of Durham City. All of the amenities including shops, restaurants and the major tourist attractions, which include the cathedral and castle, are easily accessible. Accommodation is provided for up to 60 service users in single en-suite, personalised bedrooms provided on two floors. There is a passenger lift available. The home caters for service users who require general nursing and residential care (including 24 hour nursing care) for persons aged 65 years or older. 11 of the beds are in a separate unit on the ground floor providing residential care for service users with mental health needs. There are various lounge and dining areas located throughout the home. Fees charged are between £434:40p and £636:90p. This does not include toiletries, hairdressing, chiropody and newspapers. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on 21st January and 10th February 2009. Time was spent reviewing records, speaking to members of staff, the people who live in the home, visitors to the home and to the acting manager. The company supplied some information prior to the inspection on a form called an AQAA. This is an annual quality assurance assessment for the agency to provide information about their service. Information was also received from people who use the service and their relatives. The inspection focussed on key standard outcomes for people using the service and to check whether the recommendations from the previous inspection had been met. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: What has improved since the last inspection? Some of the damaged coffee tables have been replaced as recommended in the last report. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 6 A random inspection was carried out in March 2008. This was because the CSCI had received concerns about a potential lack of management within the home. The inspectors were satisfied with the plans in place and requested that CSCI be informed in writing about the plans. The company have now appointed an acting manager. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use the service experience good quality outcomes in this area. Sufficient information is available for people to decide whether they would like to live in the home. Assessment procedures are in place to ensure that the home can meet all of the needs of the people who go to live there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People are only admitted after a full assessment of need is carried out by an appropriately trained person. This is usually the acting manager. This is to make sure that the home can meet the care needs of the people who go to live there. The family of one person who had recently gone to live in the home confirmed that they had looked around the home and had been supplied with all of the information they needed to make a decision about whether or not their relative would like to live there. All of the people who responded to the St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 9 survey said that they had received enough information about the home before they went to live there. The home does not admit people for intermediate care therefore assessment of standard 6 is not required. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. Systems are in place to ensure that health care needs of the people who live in the home are met. However they are not all person centred. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The acting manager said that all of the people who live in the home have care plans. Six were examined during the inspection. These varied as to the level of content. Some were very comprehensive and person centred, whilst others were very basic and contained clinical information only. The acting manager said that this had been identified and care plan training, particularly in the area of person centred care, was already taking place. This should make sure that the individual needs of people are met. People spoken to during the inspection said that they are happy with the care received and the level of information given. One person said, “The staff are St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 11 nice. They help me go to bed and have a bath when I want”. One visitor said, “The staff are lovely. I feel that I leave my relative in good hands”. Records examined showed that people receive visits from other healthcare professionals. These include district nurses, doctors, and care managers. Qualified nurses or appropriately trained care staff administer medication. The home has a comprehensive medication policy. Accurate records of all medicines received and those leaving the home are maintained. However where a medication dosage is prescribed as one or two, then the amount given needs to identified so that there is a clear audit trail. In addition guidelines should be available for staff to enable them to make the correct decision as to which dose to give. People spoken to said that staff generally treat them with dignity and respect. One person said, “The staff are good, they always knock and wait to be invited in”. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. The activities are varied and provide recreation for some of the people living in the home. Family and friends can visit the home at any time and are made to feel welcome. The meals are of a good standard. Menus are varied and service users are given a choice. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Most of the people said that activities are suitable. The activities organiser spends time with people on an individual basis to find out what activities they would like to do. One to one activities take place during the morning and group activities in the afternoon. Regular activities include card and board games, arts and crafts, pamper afternoons and beetle drives. Outside entertainers visit on a regular basis and a church service is held once per month. Themed events are also organised. On the first day of the inspection people were preparing to celebrate the Chinese New Year and on the second day for Valentines Day. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 13 Relatives said that they could visit at any time and that they are always made welcome. One person said, “I can have visitors at any time. They are always welcome”. People said that they have a choice about how they like to spend their day. They can also choose what time to get up and go to bed and when they would like to have a shower or bath. The lunch looked nice. Staff who were helping people were doing this in a discreet and dignified manner. Evidence was seen in care plans to confirm that nutritional needs are assessed and other professionals consulted if required. People were positive about the food and confirmed that it is good and they get a choice. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. People can be confident that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Information about complaints, how and who to make them to, is made available to the people who live in the home and their families through information displayed in the entrance to the home and in the Service Users Guide. There have been eight complaints recorded since the last inspection. None have been raised with the CSCI. However some have been dealt with by Social Services. People confirmed that they would know how to complain. One said, “I would tell the boss”. Another said, “I would tell the staff. However I feel able to raise issues and they are sorted without the need to turn it into a complaint”. The home had a comprehensive adult protection procedure. This gives staff the support they need to make a referral should this be required. The staff spoken with during the inspection were asked about abuse and what they would do if they saw or heard anything inappropriate. All said that they would tell someone, for example the manager, or make a referral themselves if this was more appropriate. Training is provided for all staff in adult protection. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 15 The home have demonstrated that they refer issues appropriately when a potential case of abuse is suspected or identified. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. People who use the service experience good quality outcomes in this area. The home is clean and well maintained. It is decorated and furnished to a good standard and provides a homely environment for the people who live there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: During a tour of the building the inspector saw that many of the rooms are decorated to the persons own taste and there was evidence to confirm that people can take in some personal items when they go to live there. This includes pieces of furniture as well as photographs and ornaments. Since the last inspection an extra bedroom has been created in the general unit. The last inspection report identified a need for some coffee tables to be replaced. This has been carried out. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 17 A good standard of decor and furniture is provided throughout the home. There was a range of equipment seen around the home to support people with bathing and mobility. The inspector found the building to be clean, tidy and free from offensive odours. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. Staff are appropriately recruited, trained and in sufficient numbers to meet the needs of the people who live in the home. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: From the rota supplied at the inspection there was sufficient care staff on duty to meet the assessed care needs of the people who were using the service. People said that staff were usually around and answered the call bells quickly. One person said, The staff come quickly when I need them. On the first day of the inspection some staff felt that staffing levels had been a problem for a few weeks. They said that they had been unable to attend to people as quickly and as often as they would have liked. Some staff also stated this on surveys. On the second day the acting manager, who had just returned to the home following a period of secondment, said that sickness had been a problem but that it had improved over the last few weeks. Generally there are two members of care staff throughout the day on the residential unit (13beds) and two on the EMI unit (11 beds). The nursing unit is staffed with two qualified nurses and five care staff throughout the day (36 beds. During the night the home is staffed throughout with one qualified nurse and five care staff. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 19 The home had staff files in place, which provided evidence that the appointment of a new staff member is in the main made through proper recruitment processes. This includes the vetting of staff through the use of references, POVA first checks and Criminal Record Bureau (CRB) checks. There is a commitment at the home to having a trained workforce with most of the staff having an NVQ at level 2 or above. As well as mandatory training, recent training has also taken place in adult protection, dementia care and health and safety. However it was identified recently that several staff needed updates in some areas. In the main these were in relation to moving and handling and person centred care planning. The acting manager has been working closely with other agencies to make sure all staff are updated in these areas. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use the service experience good quality outcomes in this area. People can be assured that the home is well managed and they are given the opportunity to comment on how the home is run. Policies and procedures are in place to safeguard their health, safety and wellbeing. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The acting manager is a qualified nurse and has completed an appropriate management course. Previous to her appointment at St Margaret’s she was the registered manager at another home within the company and had been there for several years. She was appointed in April 2008, but has been out of the St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 21 home on a secondment basis. She had returned to the home by the second day of the inspection and all of the staff spoken with confirmed that things were starting to improve with regard to staffing. She is aware that she must apply to the CSCI for registration. Regular meetings are held and there are a number of systems in place to consult with people living at the home. Relatives and the people who live in the home can approach the staff at any time. The area manager completes a regulation 26 visit monthly. This is an audit that covers all aspects of the environment and the care delivered. The manager said that during this audit staff, the people who live in the home and visitors are consulted about their views. Any suggestions made are considered and improvements made where possible. In line with company policy, the acting manager will also carry out regular audits covering all environmental and care aspects which may result in improvements being made. The acting manager said that she intends to meet with all of the staff on an individual basis and then a system for regular supervision will be put in place. Personal finances are kept in the home for people who request this. Signatures are obtained and receipts are kept to ensure peoples financial interests are safeguarded. The company also carry out a regular audit with regard to personal finances. Durham County Council have also recently undertaken an audit with regard to personal finances and found everything to be in order. The acting manager confirmed that all equipment in the home is regularly checked. The maintenance certificates that were seen at this inspection were found to be in order. Health and Safety checks are carried out regularly to safeguard people living and working at the home. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N0 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Where a medication dosage is prescribed as one or two, then the actual amount given needs to identified so that there is a clear audit trail. The acting manager must make an application to be registered with the CSCI. Timescale for action 01/04/09 2. OP31 9 01/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Some care plans should be developed further so that they are person centred. This is to make sure that the individual needs of people are met. Where a medication dosage is prescribed as one or two, guidelines should be available for staff to enable them to make the correct decision as to which dose to give. Staffing levels should be reviewed regularly to make sure they remain in sufficient numbers to meet the changing needs of the people who live in the home. DS0000000750.V373872.R01.S.doc Version 5.2 Page 24 3. OP27 St Margaret`s Care Home 4. OP36 Staff should receive formal supervision on a regular basis. It is recommended that this be at least six times per year. St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Margaret`s Care Home DS0000000750.V373872.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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